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225 Seven Farms Dr Suite 202
Charleston, SC, 29492
Phone 843-849-3492 Fax 843-849-3492
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Tax Organizer Form
Contact
Name
*
First Name
Last Name
Date of Birth
*
SSN #
*
Occupation
*
Address
*
Home Tel
*
Work Phone
*
Email Address
*
Filing Status
*
Single
Married
Married filing separately
Head of household
Qualified widow(er)
Spouse Name
*
Spouse DOB
*
Spouse SSN#S
*
Spouse Occupation
*
Dependents Name
Dependents
*
Please provide all dependents Name, DOB, SSN# and months at home.
Overpayment of Federal Taxes Prior Year
*
Overpayment of State Taxes Prior Year
*
Federal Tax Payments
*
Please provide quarterly federal tax payments including the date and the amount.
State Tax Payments
*
Please provide quarterly federal tax payments including the date and the amount.
Did you have qualifying heath care coverage, such as employer-sponsored coverage or government sponsored coverage (i.e. Medicare/Medicade) for every month of the year for your family?
*
Yes
No
Were you covered for part of the year?
*
If yes, please indicate from when to when.
Did anyone in your family qualify for an exemption from the health care coverage mandate?
*
Yes
No
Did you enroll for lower cost Marketplace Coverage through healthcare.gov under the Affordable Care Act?
*
If so please email Form(s) 1095-A you received to taxinfo@thefulpcompany.com
Yes
No
Did a lender cancel any of your debt in 2015?
*
Yes
No
Did you make energy efficient improvements to your home or purchase any energy-saving property during 2015? If yes, please email details.
*
Yes
No
Did you purchase a motor vehicle or boat during 2015? If yes, please send documentation showing sales tax paid.
*
Yes
No
If yes, enter year, make, model, and date purchased.
Did you purchase a hybrid or electric vehicle in 2015?
*
Yes
No
Did you donate a vehicle in 2015? If yes, please send Form 1098C
*
Yes
No
What was the sales tax rate in your locality in 2015?
Yes
No
Please Provide % and State ID
Did you martial status change during 2015?
*
Yes
No
If yes, please explain:
Were you or your souse permanently and totally disabled in 2015?
*
Yes
No
Do you have dependents who must file?
*
Yes
No
Do you have children who are under age of 19 or a full time student under age 24 with investment income greater than $2100?
*
Yes
No
Do you provide over half the support for any other person during 2015?
*
Yes
No
Did you incur adoption expenses during 2015?
*
Yes
No
Did you receive a total distribution form an IRA or other qualified plan that was partially or totally rolled over into another IRA or qualified plan within 60 days of the distribution?
*
Yes
No
Did you receive any disability payments in 2015?
*
Yes
No
Did you receive tip inform not reported to your employer?
*
Yes
No
Did you buy, sell , refinance, foreclose or abandon a principal residence or other real property in 2015? If yes, please send closing or escrow statements, 1099-C or 1099 A forms.
*
Yes
No
If you sold a home, did you claim the First-Time Homebuyer Credit when you purchased it?
*
Yes
No
Did you incur any casualty or theft losses during 2015?
*
Yes
No
Did you pay any individual domestic services in 2015?
*
Yes
No
Did you buy or sell any stocks or bonds in 2015?
*
Yes
No
Did you use the proceeds from Series EE or I U.S. savings bonds purchased after 1989 to pay for higher education expenses?
*
Yes
No
Did you incur any moving expenses? If yes, please send details.
*
Yes
No
Did you receive any income not included in this Tax Organizer? If yes, please send information.
*
Yes
No
Do you expect you income and deduction in 2016 to be the same as 2015? If no, attach explanation or changes expected.
*
Yes
No
Did you and your dependents have health insurance coverage for the full year? Did you receive any of the following IRS documents? Forms 1095-A (Health Insurance Marketplace Statement), Form 1095-B (Health Coverage) or Form 1095- C (Employer Provided Health Insurance Offer and Coverage)? If so, please send.
*
Yes
No
Alimony
*
If you paid Alimony, please enter the recipients SSN: Amount Of Alimony Paid:
Enter You State of Residence
*
Taxpayer
*
Spouse
*
Thank you!
